Electromyostimulation in treatment after thrombosis. Electric pulse myostimulation in the complex treatment of patients with obliterating atherosclerosis of the arteries of the lower extremities

Myostimulation (electrical stimulation, neurostimulation, physical stimulation, myolifting) - the use of impulse currents for the treatment and restoration of the natural work of muscles, tissues, nerves, internal organs... Myostimulation is widely used as a method of restorative treatment, which is based on electrical stimulation of nerves and muscles, carried out by transferring a current with specified characteristics from the myostimulator to the human body through electrodes.

This technique is in demand for the rehabilitation of patients after injuries, with diseases of the central and peripheral nervous systems, with urinary and fecal incontinence, in professional sports in cosmetology. In recent years, the method of myostimulation has become widespread in dermatocosmetology.

History of myostimulation

Since ancient times, people have used the electric action of amber and the discharges of electric fish to treat various paralysis, nervous and rheumatic pains. In ancient Egypt, electric currents generated by some species of fish were successfully used to heal the pharaohs. Using this method, ancient people cured gout, complex neuroses and many other diseases. Doctors of ancient Rome kept stingrays in their aquariums - patients were treated by touching the stingray. People who lived on the shores of the Mediterranean knew that touching the human body of certain species of fish, rays, eels, catfish causes muscle twitching, a feeling of numbness and soothing pain. The discharges of electric fish were used to treat patients suffering from headaches, joint diseases, gout, and paralysis. Even today, on the Mediterranean coast and the Atlantic coast of the Iberian Peninsula, you can sometimes find elderly people who wander barefoot in shallow water, hoping to be cured of rheumatism or gout by the natural electricity of the stingray.

The principle of myostimulation

Myostimulation is based on the effect of artificial stimulation of the muscle using an electrical signal that is generated by a myostimulator device and transmitted to the muscle. The physiological effect of electrical stimulation is based on the basic principle common to the biotronic effect of all impulse currents - short-term, rhythmically repetitive suprathreshold shifts in the concentration of basic ions (Ma +, K +, Ca +, Md +) near the semipermeable membranes of nerve, muscle and other cells of various organs and fabrics. As a result, depolarization of those excitable structures occurs, the lability of which makes it possible to perceive the acting impulse current. This leads to contraction of muscle fibers and restoration of cell function. Depending on the intensity of the impulse current and its frequency, as well as the transit time in the tissues, the structural features of the organs and tissues on which it acts, a different physiological effect occurs.

What is a muscle stimulator?

The procedure of myostimulation (electrical stimulation) is performed using special electronic devices - myostimulators, which act on the muscles with electrical impulses. In modern practice, a myostimulator is used for body shaping, losing weight, strengthening and building muscles, for people who, due to certain factors, do not have the opportunity or time for regular sports. A myostimulator is a set of electrodes that are attached to the body and a main electronic unit. In this block, a current of a certain frequency and strength is generated. Depending on the model of the myostimulator, the device can have a different purpose (for the whole body, a butterfly, in the form of a belt or shorts, to stimulate the face), have different generated power, the number of pairs of electrodes (and, accordingly, simultaneously trained muscles), the number of programs and additional functions ... Myostimulation or electrical stimulation resembles "gymnastics for the lazy" - you are at rest, and your muscles are working. Myostimulation helps to engage all excitable structures. Excitation is transmitted along nerve fibers "up" to the brain centers, and "down" to the organs under care.

Indications for the use of myostimulation:

• The need for body shaping.
• Overweight.
• Cellulite and stretch marks.
• Flabbiness of muscles, skin.
• Muscle atrophy, muscle wasting (weight loss).
• Disorders of blood circulation, lymph outflow and innervation.
• Neuromuscular pathologies.
• Venous lymphatic insufficiency.
• Sports medicine.
• Muscle injury.
• Violation of the sensitivity of the skin due to injuries and diseases of the brain and spinal cord.
• Peripheral (flaccid) paresis and paralysis (limitation of active movements) due to trauma and diseases of the nerves (neuritis).

The positive effects of myostimulation in dermatocosmetology

Myostimulants are quite simple and useful simulators. There are not so many happy owners of luxurious figures. And those who seem to be "lucky" do not always get an athletic body easily. Often a lot of workouts and procedures are hidden behind a beautiful figure. Modern electromyostimulants are designed to help everyone who wants to correct their figure and achieve a beautiful healthy body. The muscle stimulator is ideal for maintaining and training muscles, in particular those that are weakly involved in normal physical activity... These include internal muscles thighs, longitudinal muscles of the back, oblique muscles and others. Even with all the desire, for example, with active walking, running or training in the gym, these muscles remain outside the general process and can give the impression of flabbiness. In this case, myostimulation is a kind of lifeline for a person. Myostimulation helps to achieve good results with minimal exertion.

During myostimulation, pulsed electrical currents force the muscles of the body to actively contract. At the same time, there is an effect on the walls of blood vessels, which leads to an improvement in blood circulation and lymph outflow, metabolism is activated and local lipolysis occurs. All these are great tools for muscle training. Electrical stimulation increases muscle tone, helps to increase muscle mass, strengthens and develops, and also promotes the burning of fat cells. Currently, myostimulation is a popular procedure, and is actively used in many beauty salons, and is also used for lymphatic drainage.

Myostimulation is excellent for difficult cases of weak muscles of the anterior abdominal wall in women giving birth, restoring muscle tone. According to statistics, about 3-5 centimeters leave the waist. The optimal solution is the use of myostimulation in conjunction with other anti-cellulite agents - wraps, massage. The stimulation of the thigh muscles also helps to achieve good results - the volume of the thighs and the appearance of cellulite are reduced.

Electrical stimulation improves blood circulation and lymph drainage, tissue nutrition, activates metabolism, increases the permeability of the vascular walls, reserve capillaries open, motor excitement and muscle contraction are caused, and biologically active substances are formed in the stimulated tissues. The combination of these factors helps to reduce the volume of fat cells, remove metabolic products from problem areas (which is very important in cellulite), and strengthen even very weak and lazy muscles. The contractions caused by myostimulation, like the effect of massage, contribute to the faster elimination of toxins and toxins accumulated in the tissues.

The advantage of myostimulation is that it helps to get to the muscles that are located very deeply, and which in normal conditions are quite difficult to train. These include the muscles of the inner thigh, back. Another quite tangible plus of myostimulation for women is the ability to work on muscle mass without resorting to

Breaking down fat

With the help of a myostimulator, it is possible to simulate, for example, brisk walking... If you adjust the parameters of electrical stimulation in such a way that the period of contraction is equal to the period of relaxation, then as a result, the level of energy consumption will increase, and, consequently, the utilization of excess calories. This will lead to the breakdown of fat and a decrease in the volume of fat cells.

Strengthening muscles

High-quality myostimulators have fairly wide customization options and a large number of built-in programs, which allows you to reproduce an effect similar to physical exercise for any muscle group.

Improving blood circulation

The impulses created by the myostimulator cause muscle contractions, like the hands of a massage therapist. Myostimulation affects the walls of blood vessels, leading to an improvement in blood circulation and lymph drainage, and metabolic processes are activated. All this helps the faster elimination of toxins, accumulated toxic substances, excess intracellular fluid and split fat. As you know, with cellulite, blood circulation is difficult due to accumulated fat, therefore its activation is especially important.

Cellulite treatment

Many doctors - cosmetologists classify cellulite as "secondary female sex characteristics". In this fatty tissue with uneven compaction, a woman accumulates energy "for a rainy day." They try to fight the unaesthetic manifestations of cellulite, the so-called "orange peel", in various ways - from surgical (liposuction) and quasi-surgical (electrolipolysis) to chemical and biochemical anti-cellulite creams and plasters.
To date, there is no reliable evidence of effectiveness medicinal ways fight cellulite. Liposuction and electrolysis are very expensive and not always safe operations. Electromyostimulation (EMS) allows you to perform quasielectrolipolysis without surgery, without the slightest risk to health and with an efficiency of at least 60% - 70% of electrolipolysis.

Lymphatic drainage

Excessive body fat primarily disrupts lymph circulation - lymphatic drainage in the body. But it is the lymphatic system that ensures the delivery of nutrients to the tissues of the body and the removal of decay products.
By ensuring good circulation of lymph, the metabolism, the general condition of the body, skin and muscle tissue improves. The activity of the lymph circulation is determined, first of all, by the activity of the muscles, since it is their contraction that ensures the movement of lymph. Myostimulation can very effectively increase lymphatic drainage.

Muscle gain

Myostimulation allows you to solve both the problem of strengthening muscles and reducing excess weight, which especially attracts women, and the problem of building muscle volume and mass, which often worries men. The device is a very effective assistant in "bodybuilding", complementing, and in many cases, replacing intensive training with "iron". In this case, it is advisable to use a balanced protein diet.

Contraindications to myostimulation.

• The device for myostimulation is contraindicated for people who have been implanted with a biologically controlled pacemaker. It is also not recommended to use the device for those who suffer from heart diseases, especially in the stage of decompensation.
• The device for myostimulation is not recommended for use during colds, flu or other viral diseases. It is highly discouraged to use myostimulants during pregnancy, because the effect of myostimulation on pregnant women is not fully understood.
• It is not recommended to use the device-myostimulator for people suffering from diseases of the gastrointestinal tract, urolithiasis and cholelithiasis.
• The device must not be used by patients with severe mental disorders and persons suffering from alcoholism and drug addiction. The device should not be used by persons suffering from oncological diseases. If you have any chronic illness, you should consult your doctor before using the device.
• It is forbidden to place electrodes on areas of the body opposite broken bones. The pressure of the muscle during its contraction can have a negative effect on the bone fusion process.
• Do not place electrodes on the sides of the neck or on the throat.
• It is forbidden to place electrodes on inflamed skin, areas with cuts, fresh wounds, scratches, skin lesions or burns, skin rashes, or on areas that have recently undergone surgery that has passed less than 9 months.
• Do not apply electrodes to areas of the body affected by phlebitis. With thrombophlebitis, it is worth abandoning the myostimulation procedure. Classes with a myostimulator are contraindicated for people: with circulatory disorders more serious than the second stage, with renal and hepatic insufficiency, with active pulmonary and kidney tuberculosis, in the presence of hypersensitivity to impulse current.
• Do not electrostimulate the abdominal muscles within 1.5 hours after eating. The device for myostimulation is contraindicated for use in dermatoses, bleeding, a tendency to bleeding, high arterial hypertension, malignant neoplasms, acute purulent inflammatory processes, sepsis, feverish conditions, epilepsy, hernia.
• You can not use the myostimulator in intimate places, in the groin.
• Women should be extremely careful when performing breast myostimulation. It is a sad fact, but often modern women have neoplasms in the mammary glands, cysts, mastopathy. Therefore, it is necessary to consult a doctor before using the muscle stimulator.

(myostimulation, myoneurostimulation) is a method of rehabilitation treatment based on electrical stimulation of nerves and muscles. Stimulation is carried out by transferring current through the electrodes from the myostimulator to the human body. Electromyostimulation is the effect on the muscles of impulse currents in order to restore tone. A large number of contractile elements can be involved in the work, it is difficult or even impossible to influence some of them by volitional efforts.

Electrodes are placed on the skin over the site of pain. During the procedure, signals from them produce impulses that pass from the periphery to the brain. As a result, the person stops feeling pain. When stimulated at a low frequency, the pain disappears due to the release of hormones - endorphins. This technique provides the ability to combat pain with little or no medication and has been used for decades. Initially, it was used as a gymnastics for bedridden patients who did not have the opportunity to exercise.

This method of therapy is used for the rehabilitation of patients with venous diseases, diseases of the central and peripheral nervous systems, after injuries, with urinary and fecal incontinence, as well as in cosmetology and in professional sports. The field of application of electromyostimulation is expanding all the time. The therapy regimen is developed individually for each patient. All sessions are supervised by a physiotherapist or a special instructor.
The method of myostimulation effectively works in combination with other rehabilitation measures aimed at restoring muscle tissue after various surgical interventions, as well as fractures and injuries.

Method effectiveness

This therapy is also prescribed to improve the functioning of paretic limbs in patients who have suffered a stroke. With the help of the procedure, patients restore the ability to use their hands, and their gait also improves. In addition to the analgesic effect and strengthening of muscle tissue, myostimulation activates blood and lymph circulation, lipid breakdown (local lipolysis). Also, during the procedure, the hormonal background is normalized and positive changes in fat metabolism occur. Electromyostimulation provides gas exchange and metabolism in tissues without accumulation of lactic acid.
Myostimulation of the back muscles is effective for the treatment of scoliosis and osteochondrosis, and the stimulation of the abdominal press helps to restore its tone in women after childbirth, while having a beneficial effect on the internal organs. age changes and anti-wrinkle treatment for all skin types. Electrical impulses act on the neuromuscular apparatus, improving their motor function with reduced tone and atrophy of the skin and subcutaneous tissues. The procedure has a positive effect on dull and aging skin.

Electromyostimulation in Kiev is used in phlebology for treatment vascular diseases... An experienced phlebologist, after a thorough examination, will prescribe this procedure for you if necessary.

Contraindications for electromyostimulation:

Pregnancy;
the presence of metal implants (hip joints, spine) with the exception of dental implants;
the presence of an implanted pacemaker;
cardiovascular diseases;
mental disorders.

Electric current is an invaluable aid in medical and cosmetic procedures. For procedures in which electric current is involved, a special apparatus is used - a myostimulator.

Varicose veins can cause a lot of trouble for a person. To reduce the negative impact of pathology on the human body and prevent the development of complications, various methods are used. For example, such a method as myostimulation for varicose veins has proven itself well.

Myostimulation with varicose veins of the legs affects the venous vessels, and a timely appeal to the attending physician for help and timely stimulation with electrical impulses of the limb allows not only to eliminate the disease, but also to prevent the appearance and progression of complications.

The essence and principle of the procedure

Exposure to a muscle or muscle group using an electric current is called myostimulation. To influence muscle structures, a special device is used - a myostimulator.

The principle of operation of this device is quite simple. Electrodes are attached to certain areas of the body, through which the apparatus delivers electrical impulses of a certain power and frequency to the body. Electrical impulses, acting on muscle structures, cause muscle fibers to contract.

The increased work of muscle fibers accelerates the course of metabolic processes in cells. Thanks to this effect, tissue cells begin to renew themselves faster. Which leads to increased blood flow and lymph flow. The latter factor helps to increase the nutrition of tissue cells.

Electrical impulses sent to muscle structures by a myostimulator. They are similar to those produced by the nerve endings of brain cells. The work of a myostimulator is similar to the effect of a defibrillator or a pacemaker.

When using the device, the resulting positive effect is as follows:

• metabolic processes are stabilized;
• laxity of the skin is eliminated;
• there is a tightening of muscle tissue;
• there is a positive effect on the work of the most important systems of the body;
• muscle pain syndrome is eliminated;
• the impact on muscle structures is carried out at a deep level.

The appointment of the procedure, its duration and duration of the course of myostimulation, as well as the intensity and strength of the electrical impulse is carried out by the attending physician, taking into account the results of the examination and taking into account individual characteristics the patient's body.

Despite the presence of a powerful positive effect on the body of myostimulation, it should be prescribed taking into account the possible presence of contraindications in the patient for such a procedure.

Such contraindications are the following situations and conditions:

1. The period of bearing a child.
2. The patient has diseases of cardio-vascular system or having a pacemaker.
3. Identification of oncological foci in the patient.
4. Periods of exacerbation of chronic diseases.
5. The patient has mental disorders and epilepsy.
6. Identification of urolithiasis and gallstone disease in a patient.
7. Diagnosis of uterine fibroids.
8. Diagnosis of infectious and viral diseases in a patient.
9. Skin damage or inflammation on the surface of the skin.
10. The patient has diseases of the blood system.

The list of contraindications is quite extensive. This is due to the fact that electrical impulses affect not only muscle structures, but also the vascular system, forcing most of the internal organs to function intensively.

Myostimulation for varicose veins - for and against

Progression gives a person a lot of problems. The presence of this ailment forces the patient to abandon a large number of joys of life, such as, for example, the use of certain products and the refusal to use shoes with heels, in addition, in the presence of varicose veins, it is forbidden to engage in many sports.

In addition to the above, the patient develops a large number of uncomfortable sensations, such as swelling of the limbs, heaviness in the legs, stiffness in the movements of the lower limbs and the appearance of severe pain in the legs.

In the list of contraindications to the use of myostimulation, varicose veins are on a separate line, so many patients are wondering whether it is possible to do myostimulation with varicose veins of the lower extremities.

A categorical ban on the use of this technique is appropriate only if the disease has reached the last stage of its progression and the patient begins to develop complications against the background of varicose veins.

This prohibition is due to the fact that the effect of a myostimulator accelerates blood flow and can provoke a detachment of a formed thrombus or rupture of the affected venous wall. Such pathological condition becomes extremely life-threatening for the patient.

When detecting varicose veins on initial stages the use of stimulation with high frequency electric current is not only legal, but also beneficial.

The procedure at the time of its implementation leads to relaxation of muscle tissue and expansion of venous vessels, promotes blood flow acceleration, which counteracts the formation of stagnation. The absence of congestion prevents the formation of blood clots.

With the timely detection of varicose veins in the early stages and the use of myostimulation procedures at this stage, it helps to successfully eliminate existing complications and prevent the emergence of new ones. High frequency electrical stimulation is an excellent remedy.

The location of the electrodes during the myostimulation procedure in the presence of varicose veins should be such that they do not affect the affected areas and the areas adjacent to them.

The treatment course should be carried out under the strict supervision of the attending physician. For the procedure, you should contact a specialized institution. It is strictly forbidden to use such a technique on your own at home.

If varicose veins began to develop during the period of childbearing, the use of myostimulation is not recommended, since it is not known for certain how electrical impulses can affect the body of a future mother and child.

Subject to all medical recommendations and under the vigilant supervision of the attending physician, myostimulation with varicose veins of the lower extremities can significantly improve the patient's condition and cope with the disease on initial stage its development.

Possible consequences of the hardware procedure

The procedure is allowed only under the strict supervision of a qualified specialist.

During the course of stimulation, the electrodes of the device must be placed on certain areas of the skin. The location of the electrodes is indicated by the attending physician. Violation of the rules for the placement of electrodes can provoke the appearance of undesirable consequences in the patient, including cardiac arrest.

One of the possible consequences of the procedure may be the appearance of redness and inflammation of the skin area at the site of the electrode attachment to the skin. Such a negative effect on the skin most often disappears after 3-4 days.

When the procedure is performed by an unqualified specialist, the patient may experience skin burns, electrical injury and an increase in muscle tone above normal.

Electric current is a rather dangerous thing, for this reason strict adherence to safety rules and operating rules is required. Failure to comply with these requirements can lead to serious negative processes in the patient's body.

Myostimulation is a procedure based on the effect of current on muscle tissue... This leads to increased tone of muscle structures, elimination of toxins from the body. In addition, myostimulation actively contributes to the reduction of body fat.

The use of stimulation with high frequency electric current has a positive cosmetic effect on the body. An improvement in the condition of the skin is observed, the number of wrinkles decreases, and the contours of the body are corrected.

Judging by the reviews of patients who used the procedure in the early stages of development of varicose veins, it can not only improve the general condition of the body, but also save a person from most of the unpleasant symptoms accompanying the disease.

What is myostimulation is described in the video in this article.

In some diseases, the condition of the patient's musculature is of key importance, one of such diseases is osteochondrosis. The patient's condition and well-being directly depend on the level of training of the muscular corset of the spine.

How to strengthen the muscle corset if there is no possibility or there are contraindications to physical exercise? The answer is to take a course of myostimulation.

What is myostimulation?

Myostimulation - the impact on the muscles with an impulse current, which causes them to contract, just like during normal exercise

Myostimulation (myolifting, neurostimulation, electromyostimulation) is a type of physiotherapeutic procedures for "artificial" muscle training.

This treatment was developed for patients with temporary loss of motor function in order to prevent the development of muscle atrophy.

Now myostimulation is used in many branches of medicine and cosmetology.

The essence of the procedure is to supply the patient's muscle with a weak electrical discharge of a pulsed current, similar to that which occurs when a nerve impulse is conducted.

The muscle reflexively contracts and relaxes, gradually exercising and strengthening.

Myostimulation is actively used to relieve pain in osteochondrosis and maintain the support of the spine

It is extremely important for patients with osteochondrosis to keep the back muscles in working order. Read about how to strengthen the back muscles with the help of gymnastics for cervicothoracic osteochondrosis.

A strong corset made of muscles relieves stress from the damaged spine, which slows down the development of osteochondrosis.

For these purposes, the method of myostimulation is often used - the possibility of selectively affecting the required muscles gives an excellent result in the complex strengthening of the muscular corset of the spine.

Pain syndrome, which is the main complaint of patients with osteochondrosis, in 90% of cases is caused by muscle spasm in the affected area. Exposure to the impulse current helps to relax the muscle and return it to its normal state, relieving the patient of pain.

Contraindications

Even the most effective method of treating any disease has its own contraindications - conditions in which it can harm the patient. Myostimulation is no exception.

The use of this method is contraindicated in patients with chronic diseases blood and a tendency to thrombosis, with cardiac or renal failure, oncological diseases.

If at the time of planning the start of therapy the patient is sick with a viral disease, accompanied by an increase in temperature or massive inflammatory processes, it is better to postpone the course of myostimulation until complete recovery.

If the patient has dermatological diseases, this can disrupt the conduction of current, which will negatively affect the result.

Patients with heart disease who have a pacemaker are contraindicated in myostimulation treatment.

Sometimes there is intolerance to the impulse current, which makes it impossible to complete the course.

In what cases is myostimulation prescribed?

Back muscle training is always useful, in the absence of contraindications. Doctors strongly recommend that patients undergo a course of myostimulation in the following cases:

1. In the presence of severe pain syndrome due to muscle spasm in osteochondrosis;
2. If there are contraindications or the stage of osteochondrosis does not allow you to engage in physiotherapy exercises;
3. When proven hypo- and hypertonicity of individual muscles of the back;
4. For general strengthening of the back muscles and maintaining the body - how additional method treatment of osteochondrosis.

Where and how does the procedure take place?

The procedure for osteochondrosis takes place in specialized medical centers

Myostimulation courses for the treatment of osteochondrosis are carried out in specialized medical centers or in private orthopedic offices.

When choosing a place to take a course, it is important to start not on the price, but on the quality and recommendations.

The office must have sanitary and hygienic certificates, the specialist must present a certificate and license to conduct this type of treatment.

After the diagnosis of osteochondrosis and consultation with his attending physician, the patient comes to the myostimulation office.

Undresses to the waist, lies down on the couch. Electrodes are attached to the skin in the projections of the necessary muscles (professional myostimulator has 10-56 electrodes) and the session begins. There may be a slight tingling sensation in the electrode area.

If for some reason it is impossible to undergo a course of treatment in a specialized institution, there is an option to do myostimulation at home.

For this, it is necessary to discuss with a competent specialist the tactics, the duration of the session and the points of placement of the electrodes.

To find out possible complications and unforeseen situations. If the doctor allows you to undergo a course of treatment at home, the matter remains small - choose myostimulator.

The device is a compact device consisting of a control box and electrodes. Home muscle stimulants have 2 to 4 electrodes.

All of them are easy to operate - the electrodes are attached to the skin, the device is turned on at the selected frequency and the session begins.

When choosing a muscle stimulator, it is advisable to observe a few points:

1. the device must be powered by the network;
2. electrodes must be sewn into washable pockets;
3. several modes must be present.

How effective is the procedure?

The mechanism of action of the myostimulator is similar to the impulses sent by the brain, due to which the muscles work in full.

Subject to a qualified session, all the doctor's requirements are met, the effect of myostimulation exceeds all expectations.

Quick release of the spasm relieves the patient from pain after the first visit to the office.

INTRODUCTION

Chapter 1. MODERN APPROACHES TO THE MECHANICAL PREVENTION OF POSTOPERATIVE VENOUS THROMBOEMBOLIC COMPLICATIONS IN SURGICAL PATIENTS

1.1 Epidemiology of deep vein thrombosis and pulmonary embolism.

1.2 Features of venous thromboembolism in high-risk surgical patients.

1.3 Blood stasis as the main component of the pathogenesis of venous thrombosis.

1.4 Methods of dealing with venous stasis in surgical patients.

1.4.1. Methods for accelerating venous outflow and their effectiveness

1.4.1.1. Elevated position of the lower limbs, active muscle contractions, early activation.

1.4.1.2. Elastic compression.

1.4.1.3. Intermittent pneumatic compression.

1.4.1.4. Electrical stimulation of the calf muscles.

1.4.1.5. Combined use.

1.4.2. The value of venous blood flow velocity parameters for thromboprophylaxis.

1.4.3. Blood flow velocity and shear stress are factors in maintaining the thromboresistant properties of endothelium.

CHAPTER 2. CHARACTERISTIC OF MATERIALS AND RESEARCH METHODS

2.1. Characteristics of the experimental part of the work.

2.1.1. General characteristics of the subjects.

2.1.2. Study of regional venous hemodynamics of the lower extremities by the method of duplex angiscanning.

2.1.3. Characteristics of research conditions and methods for accelerating blood flow.

2.2. Characteristics of the clinical part of the work.

2.2.1. General characteristics of patients and methods of examination.

2.2.2. Assessment of risk factors for the development of venous thromboembolism.

2.2.3. Methods for the diagnosis of venous thromboembolic complications.

2.2.3.1. Ultrasound angioscanning.

2.2.3.2. Perfusion lung scintigraphy.

2.2.3.3. ECHO cardiography.

2.2.3.4. Sectional research.

2.2.4. Description of methods of prevention of venous thromboembolism.

2.2.4.1. Elastic compression.

2.2.4.2. Electromyostimulation of venous outflow.

2.2.4.3. Pharmacological prophylaxis.

2.3 Methods for statistical processing of results.

CHAPTER 3. EXPERIMENTAL RESULTS AND THEIR ANALYSIS

3.1 Results of measurements of the popliteal vein diameter.

3.2 Results of measurements of peak blood flow velocity in the popliteal vein.

3.3 Results of measuring the volumetric blood flow velocity in the popliteal vein.

3.4 Influence of myostimulation on the sural sinuses and assessment of Doppler curves and myostimulation power.

3.5. Selection of the optimal combination of blood flow acceleration methods based on the data obtained.

3.6 Factors affecting blood flow velocity during muscle contraction.

CHAPTER 4. RESULTS OF THE "EPIDEMIOLOGICAL" STAGE OF THE RESEARCH AND THEIR ANALYSIS

4.1 General characteristics of postoperative venous thrombosis.

4.1.1. Localization of the thrombotic process.

4.1.2. The timing of the development of venous thrombosis.

4.1.3. The total number of risk factors and the incidence of thrombosis.

4.2 General characteristics of pulmonary embolism.

4.3 General mortality, causes of death, complications of preventive techniques and other characteristics of the study.

4.4. Analysis of the results obtained.

CHAPTER 5. RESULTS OF THE "COMPARATIVE" STAGE OF RESEARCH AND THEIR ANALYSIS

5.1 Results of using myostimulation in the pilot group.

5.2 Algorithm for the use of electrical stimulation of the leg muscles as part of the complex prevention of venous thromboembolic complications.

5.3 Efficiency integrated program prevention of venous thromboembolic complications using myostimulation technique and graduated compression bandage with an increased pressure level.

5.4 Experience of myostimulation in acute thrombosis.

Recommended list of dissertations

• Optimization of methods of prevention of acute venous thrombosis in surgical patients with a high risk of thromboembolic complications 2014, Doctor of Medical Sciences Barinov, Victor Evgenievich

• Prediction and prevention of postoperative venous thromboembolic complications 2008, Doctor of Medical Sciences Vardanyan, Arshak Vardanovich

• Deep venous thrombosis and pulmonary embolism: diagnosis, risk prediction, treatment in the early period of traumatic disease 2006, Doctor of Medical Sciences Mishustin, Vladimir Nikolaevich

• Complicated forms of chronic venous insufficiency (pathogenesis, diagnosis, treatment, prevention) 2004, Doctor of Medicine Shchelokov, Alexander Leonidovich

• Choice of a method for surgical prevention of pulmonary embolism (PE) 2004, Candidate of Medical Sciences Korelin, Sergey Viktorovich

Dissertation introduction (part of the abstract) on the topic "Electromyostimulation of venous outflow in the prevention of venous thromboembolic complications in surgical patients."

Venous thromboembolic complications, including acute venous thrombosis and pulmonary embolism, have remained an urgent public health problem for many decades. Despite the active introduction of new preventive techniques and the constant improvement of preventive protocols, the incidence of these complications in hospitalized patients is about 10 times higher than the same frequency in the general population and is growing steadily. In surgical patients, venous thromboembolism is the second most frequent postoperative complication, the second most common cause of hospital stay and the third most common cause of postoperative mortality, accounting for up to 50% of deaths after the most common operations. The reason for such sad dynamics can be both insufficient coverage of inpatients with preventive measures, and a progressive increase in the number of hospitalizations of patients from the category of high risk of developing VTEC, whose share in a surgical hospital today reaches 41%. According to a number of authors, standard preventive approaches in this category of patients demonstrate insufficient effectiveness. According to the generalized literature data, the incidence of postoperative venous thrombosis against the background of complex prophylaxis in high-risk patients can reach 25-30% and averages about 12%. This dictates the need for a more thorough study of the epidemiology of venous thromboembolism in this population and the search for new more effective methods and approaches to their prevention.

Against the background of the progressive development of the pharmaceutical industry and the emergence of new antithrombotic drugs on the market, less and less attention of researchers is attracted by mechanical means of VTEC prevention aimed at arresting venous stasis. Meanwhile, blood stagnation is an integral companion of the perioperative period and an important component of the pathogenesis of venous thrombosis. In this case, the main zones of stagnation are the veins and sinuses of the gastrocnemius and soleus muscles, where in most cases the thrombotic process begins in the inferior vena cava system. Adequate emptying of the sinuses provides only a contraction of the advising muscles, while traditional compression techniques, according to a number of authors, are not able to effectively drain these areas.

At the same time, the method of electrical stimulation of the calf muscles, which found wide clinical application in the second half of the 20th century and then lost itself against the background of simpler and more accessible methods of VTEC prevention, has an effect directly on the muscles of the calf and can become effective remedy emptying the sural sinuses and combating venous congestion. The appearance on the market of modern safe portable devices for EMC requires an assessment of their hemo-dynamic and clinical efficacy in the prevention of VTEC, especially in high-risk patients. And if the hemodynamic effect of the use of myostimulation is reflected in the literature, the results of the clinical use of modern devices are currently absent. Considering that the prevention of thromboembolism in high-risk patients should be multicomponent, research is also required on the effectiveness of the combined use of EMS and compression therapy.

Purpose of the study

To improve the results of treatment of surgical patients with a high risk of developing venous thromboembolic complications in the postoperative period by developing and implementing a therapeutic and prophylactic complex of measures, including electrical stimulation of the leg muscles and a graduated compression bandage.

1. Evaluate the hemodynamic efficiency of the technique of electrical stimulation of the leg muscles and choose the optimal compression profile for joint use.

2. Explore epidemiological features postoperative venous thrombosis developing in high-risk patients with the use of standard preventive measures.

3. To determine the significance of the muscle veins and sinuses of the lower leg in the development of postoperative venous thromboembolic complications.

4. To evaluate the effectiveness of the method of electrical stimulation of the leg muscles in preventing the development of venous thrombosis and pulmonary embolism.

5. Determine the optimal myostimulation regimen and develop an algorithm for its use in surgical patients with a high risk of developing venous thrombosis.

Scientific novelty:

1. A direct strong relationship was found between the total number of predisposing factors and the incidence of postoperative venous thrombosis in surgical patients.

2. It was found that within the high-risk group, patients with three or more predisposing conditions exhibit the highest incidence of postoperative venous thrombosis.

3. The hemodynamic efficiency, feasibility and safety of clinical use of a graduated compression bandage with an increased pressure level were evaluated.

4. The profile of a compression bandage was revealed, which provides an optimal hemodynamic response when used together with the technique of electrical stimulation of the leg muscles in the framework of complex prevention of venous thrombosis.

5. Evaluated clinical effectiveness a portable device for electrical stimulation of the leg muscles, generating modulated frequency electrical impulses in the range of 1-250 Hz with a burst frequency of 1-1.75 Hz, in the prevention of postoperative venous thrombosis and pulmonary embolism.

6. An algorithm has been developed for the application of the myostimulation technique in high-risk surgical patients within the framework of a comprehensive program for the prevention of venous thromboembolism.

Provisions for Defense:

1. Electrical stimulation of the lower leg muscles by the device "Wetop1sh" provides a hemodynamic response comparable to active muscle contraction, while the linear blood flow rate is 4-5 times higher than the basal rest level, and the sural sinuses show signs of effective emptying.

2. The optimal level of compression for combined use with electromyostimulation in a horizontal position of the body, providing significant acceleration while theoretically maintaining the laminarity of the venous blood flow in the popliteal vein, is a compression profile with a pressure level of 20-40 mm Hg. in the distal section.

3. Veins and sinuses of the gastrocnemius and soleus muscles are the main sources of thrombosis in the inferior vena cava system and can cause pulmonary embolism in high-risk patients receiving standard complex prevention of venous thromboembolic complications.

4. The incidence of postoperative venous thrombosis against the background of standard preventive measures in high-risk patients can reach 26.7-48.8%, while in half of the cases the thrombotic process is limited to the sural sinuses.

5. With an increase in the total number of risk factors, the likelihood of developing postoperative venous thrombosis increases with standard prophylaxis. In this case, the presence of three or more risk factors in a patient is critical, which increases the likelihood of thrombosis by 10 times.

6. The inclusion of electrical stimulation of venous outflow by the device "Uetop1u8" in the complex prophylaxis can significantly reduce the risk of venous thrombosis in patients from the high-risk category.

7. Electromyostimulation with the use of the device "Wetop1sh" in high-risk patients should be performed at least 5 times a day (\u003e 100 minutes a day).

The practical value of the work

The study allows to improve the results of treatment of surgical patients by reducing the incidence of postoperative venous thrombosis and pulmonary embolism. The developed model of individual stratification of the likelihood of postoperative venous thrombosis on the basis of identifying traditional conditions predisposing to the development of thrombosis and taking into account their total number makes it possible to identify the most thrombotic contingent of patients within the high-risk group. The use of a complex of preventive measures in this category of patients with the inclusion of electrical stimulation of the leg muscles and a graduated compression bandage provides more reliable protection against these complications in comparison with the traditional preventive protocol. The algorithm for the use of electromyostimulation, developed on the basis of the performed clinical and experimental study, is easy to use and effective, which determines the prerequisites for its widespread implementation in practical healthcare.

Implementation of work results into practice

The results of the study were introduced into the clinical practice of the Department of General Surgery and Radiation Diagnostics of the Faculty of Medicine of the Russian National Research Medical University named after N.I. Pirogov, surgical departments and intensive care units of city clinical hospitals No. 12 and No. 13 of the Moscow Department of Health.

Dissertation approbation

The main provisions of the dissertation were reported at a joint scientific-practical conference of the Department of General Surgery and Radiation Diagnostics of the Faculty of Medicine, State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia and surgical departments of the City Clinical Hospital No. 24 and the City Clinical Hospital No. 13 of the Moscow Department of Health 12.10.2012

Publications

Based on the materials of the dissertation, 5 scientific articles were published in peer-reviewed journals recommended by the Higher Attestation Commission for publication of scientific research for the degree of candidate of medical sciences. Also, the research results were reported at conferences: at the XI Congress of Surgeons Russian Federation (Volgograd, 2011), at the IX conference of the Association of Russian florists (Moscow, 2012), at the 5th St. Petersburg venous forum

St. Petersburg, 2012), at scientific and practical conferences GKB No. 12 and KB No. 1 UPDP RF.

The structure and scope of the thesis

The dissertation consists of an introduction, 5 chapters, conclusions, conclusions, practical recommendations, applications and a list of references. The bibliography consists of 28 domestic and 289 foreign sources. The thesis is presented on 180 pages of typewritten text, illustrated with 20 tables and 17 figures.

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Thesis conclusion on the topic "Surgery", Lobastov, Kirill Viktorovich

1. Electrical stimulation of the lower leg muscles with a portable device "Wetop1sh" makes it possible to accelerate venous outflow from the lower extremities no less effectively than active muscle contraction. The optimal compression level for combined use with myostimulation is a graduated compression profile with a pressure level in the distal region of 20-40 mm Hg.

2. Against the background of a standard set of preventive measures in high-risk patients, the incidence of acute venous thrombosis in the postoperative period can reach 37.1% (26.7-48.8%), while in half of the cases, isolated lesions of the sural sinuses are observed ... The total number of conditions predisposing to thrombosis in these patients significantly correlates with the frequency of verification of postoperative venous thrombosis, and patients with three or more risk factors are 10 times more likely to suffer from this complication, which allows them to be classified as “extremely high risk”.

3. Veins and sinuses of the gastrocnemius and soleus muscles are the main zones of initiation of thrombosis in the inferior vena cava system and can serve as independent sources of pulmonary embolism. Their defeat is observed in 84.6% (74.4% -91.2%) of all venous pomboses.

4. Electrical stimulation of the lower leg muscles by the Uetoplus apparatus, used as part of the complex prevention of venous thromboembolism, can significantly reduce the risk of venous thrombosis in high-risk surgical patients.

5. The minimum effective frequency of electrical stimulation of the lower leg muscles by the Uetop1sh apparatus in high-risk patients is 7 procedures per day for intensive care units and 6 procedures per day for specialized surgical departments.

1. If a patient from a high-risk group has three or more conditions predisposing to thrombosis, it should be referred to the most thrombotic contingent, requiring an individual approach to the prevention of venous thromboembolism, the use of a complex of the most effective preventive measures and dynamic control over the patency of the veins of the lower extremities.

2. To reduce the risk of postoperative venous thrombosis in high- and extremely high-risk patients, the technique of electrical stimulation of the leg muscles should be more widely used, which ensures effective drainage of venous stagnation zones and accelerates blood flow.

3. When using the device "Weshurch" in patients from the high and extremely high risk group, it is necessary to carry out procedures with a frequency of at least 7 times a day for intensive care units and 6 times a day for specialized surgical departments.

4. Myostimulation should be used during the entire period of the presence of risk factors for venous thromboembolism in patients, including after its successful activation.

5. For the timely detection of asymptomatic venous thrombosis in high and extremely high risk patients, it is necessary to carry out active ultrasound screening, especially during the first week after surgery and during intensive care.

6. When conducting ultrasound examination veins of the lower extremities, it is imperative to examine the veins and sinuses of the gastrocnemius and soleus muscles, because they are the main source of thrombus formation in the inferior vena cava system and can serve as an independent source of pulmonary embolism.

7. To increase the efficiency and safety of using an elastic bandage as a means of compression effect, a bandage should be applied under pressure control using a portable pressure gauge, or the technique of applying a bandage with manometry should be practiced in advance. The composition of the bandage must include a lining material to reduce the frequency of damage to the skin and soft tissues of the lower leg.

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